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	<title>电子病历</title>
</head>
<body>
	<div class="html-loding"><img src="../../images/zhuanchang.gif"></div>
	<form id="thisform">
		<input type="hidden" name="birthday" value="" />
		<input type="hidden" name="ourself" value="" />
		<div  class="mui-input-group font3">
			<div class="mui-table-view-cell">
				与你的关系
				<span class="mui-pull-right" id="forme">请选择</span>
			</div>
			<div class="mui-input-row">
				<label>姓名</label>
				<input type="text" placeholder="请输入姓名" class="textR" name="name">
			</div>
			<div class="mui-input-row">
				<label>患者性别</label>
				<div class="rapidly-sex">
					<div class="mui-radio mui-left">
						<label>男</label>
						<input name="sex" type="radio" checked="" value="1" >
					</div>
					<div class="mui-radio mui-left">
						<label>女</label>
						<input name="sex" type="radio" value="2">
					</div>
				</div>
			</div>
		</div>
		<div  class="mui-input-group font3">
			<div class="mui-table-view-cell">
				出生日期
				<span class="mui-pull-right" id="birthday">请选择</span>
			</div>
			<div class="mui-input-row">
				<label>手机号码</label>
				<input type="text" placeholder="请选输入" class="textR mui-input-clear" value="" id="phoneNumber" name="phoneNumber">
			</div>
		</div>
	</form>
	<div class="submitBottom">
		<button id="nextBtn">确定</button>
	</div>
</body>
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